A Novel 3D Light Assisted Drawing (3D-LAD) Method to Aid Intraoperative Reproduction of Osteotomy Lines Surrounding a Bone Tumor During Wide Resection: An Experimental Study

Abstract

Introduction

Computer navigation and customized 3D-printed jigs improve accuracy during bone tumor resection, but such technologies can be bulky, costly, and require intraoperative radiation, or long lead time to be ready in OR.

Methods

We developed a method utilizing a compact, inexpensive, non-X-ray based 3D surface light scanner to provide a visual aid that helps surgeons accurately draw osteotomy lines on the surface of exposed bone to reproduce a well-defined preoperative bone resection plan. We tested the accuracy of the method on 18 sawbones using a distal femur hemimetaphyseal resection model and compared it with a traditional, freehand method.

Results

The method significantly reduces the positional error from 2.53 (±1.13) mm to 1.04 (±0.43) mm (p<0.001), and angular error of the front angle from 2.10° (±0.83°) to 0.80° (±0.66°) (p=0.001). The method also reduces the mean maximum deviation of the bone resection, with respect to the preoperative path, from 3.75mm to 2.69mm (p=0.003). However, no increased accuracy was observed at the back side of the bone surface where this method would not be expected to provide information.

Discussion

In summary, we developed a novel 3D-LAD navigation technology. From the experimental study, we demonstrated that the method can improve the ability of surgeons to accurately draw the preoperative osteotomy lines and perform resection of a primary bone sarcoma, with comparison to traditional methods, using 18 sawbones.

Keywords:

• computer-assist surgery
• 3D light assisted drawing
• osteotomy lines
• structured-light scanning
• surgical technique

Sources of Support

NaviSect (previously was named “Khan Surgical Systems”).

Acknowledgment

We thank Charlie Mazzerese, MS from the Stony Brook University Department of Radiology for their assistance with this project. The first two authors contributed equally to this manuscript, therefore, claim co-first authorship. The last two authors contributed equally to this manuscript, therefore, claim co-senior authorship.

Disclosures

Fazel A. Khan, MD is one of the owners of NaviSect, INC (previously “Khan Surgical Systems, INC”). In addition, Dr. Fazel A Khan has a patent US20200360093A1 pending to Fazel Khan.

Guangyu He, Imin Kao, and Fazel A. Khan have a patent US Patent Application No. 16/854,804 licensed to NaviSect.

Dr Imin Kao reports a patent System and Method to Conduct Bone Surgery pending.

The other authors certify that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.